Abstract: Objective: To report surgical management and favorable outcome in a case with delayed repair of traumatic laser in situ keratomileusis (LASIK) flap dislocation with shrinkage and folds. Methods: A 30-year-old man with a five-year history of bilateral LASIK experienced blunt trauma to his right eye followed by decreased vision for 5 weeks. The surgical management included initially softening the flap by irrigation with balanced salt solution (BSS). The shrinkage folds were carefully and gently stretched by scraping with a 26-gauge cannula accompanied by BSS irrigation. All of the epithelial ingrowth on the flap inner surface and on the bed was thoroughly debrided by scraping and irrigation. After the flap was repositioned to match its original margin, a soft bandage contact lens was placed. Results: At his initial visit, slit-lamp microscopy and optical coherence tomography (OCT) showed shrinkage of the LASIK flap with an elevated margin approximately 3 mm above the original position. The flap covered half of the pupil and had multiple horizontal folds. Two months after surgery, the flap remained well positioned with only faint streaks in the anterior stroma. The uncorrected visual acuity of the right eye was 20/20 with a manifest refraction of Plano. Conclusions: For delayed repair of traumatically dislocated LASIK flaps, sufficient softening by BSS, stretching the shrinkage folds, and thorough debridement of ingrowth epithelium enable resetting the flap and provide satisfactory results.

冲洗伸展清创法处理延迟复位的LASIK术后外伤性瓣移位伴皱缩的良好临床结果

[1]Cheng, A.C., Rao, S.K., Leung, G.Y., et al., 2006. Late traumatic flap dislocations after LASIK. J. Refract. Surg., 22(5):500-504.

[2]Davies, J.B., Randleman, J.B., 2008. Successful delayed surgical revision of a dislocated LASIK flap. Ophthalmic Surg. Lasers Imag., 39(3):221-224.

[3]Dawson, D.G., Kramer, T.R., Grossniklaus, H.E., et al., 2005. Histologic, ultrastructural, and immunofluorescent evaluation of human laser-assisted in situ keratomileusis corneal wounds. Arch. Ophthalmol., 123(6):741-756.

[4]Holt, D.G., Sikder, S., Mifflin, M.D., 2012. Surgical management of traumatic LASIK flap dislocation with macrostriae and epithelial ingrowth 14 years postoperatively. J. Cataract Refract. Surg., 38(2):357-361.

[5]Kim, H.J., Silverman, C.M., 2010. Traumatic dislocation of LASIK flaps 4 and 9 years after surgery. J. Refract. Surg., 26(6):447-452.

[6]Landau, D., Levy, J., Solomon, A., et al., 2006. Traumatic corneal flap dislocation one to six years after LASIK in nine eyes with a favorable outcome. J. Refract. Surg., 22(9):884-889.

[7]Melki, S.A., Talamo, J.H., Demetriades, A.M., et al., 2000. Late traumatic dislocation of laser in situ keratomileusis corneal flaps. Ophthalmology, 107(12):2136-2139.

[8]Nilforoushan, M.R., Speaker, M.G., Latkany, R., 2005. Traumatic flap dislocation 4 years after laser in situ keratomileusis. J. Cataract Refract. Surg., 31(8):1664-1665.

[9]Pallikaris, I.G., Papatzanaki, M.E., Siganos, D.S., et al., 1991. A corneal flap technique for laser in situ keratomileusis. Human studies. Arch. Ophthalmol., 109(12):1699-1702.